Psychiatric disability and service animals

This post has taken a while to percolate, and has turned into two posts.  As often happens, what got me thinking was an article in the New York Times, this time on the expanding definition and use of service animals by the disabled.  Service animals now go far beyond Seeing Eye dogs.  The article introduces us to monkeys, miniature horses, even a parrot.  A quadriplegic’s assistance by a trained monkey strikes me as ingenious.  In certain respects a horse is better than a dog as a service animal for the blind.  But psychiatric service animals are a trickier issue, and quickly lead to complex questions about labels, stigma, entitlement, and how disability is defined.

My introduction to this issue came long before the NY Times article.  Years ago a patient asked me to write to her landlord, arguing that her building’s no-pets policy should not prevent her from keeping a dog for emotional support.  I felt reluctant to write such a letter.  Doesn’t everyone get emotional support from a pet dog?  On what basis could I argue that my patient was more entitled to a dog than her neighbors were?  On what basis did she believe she was more entitled?

I did not quiz my patient about her rationale.  It seemed she would truly benefit emotionally from keeping her dog, and on that basis I did end up writing a short letter.  I asked, not demanded, that the landlord consider making an exception in view of my patient’s emotional condition (which of course I did not specify).  Whether due to the clout of my letterhead or other reasons, the exception was granted, and my patient kept her dog.  Yet I was never quite sure if that was a good outcome.

The law distinguishes service animals and “comfort” or “therapy” animals.  The latter are not necessarily trained, and enjoy no special legal status.  When I worked on a psychiatric inpatient unit in the early 1990s, a volunteer would usher in animals for “pet therapy.”  These were extremely cute and docile dogs, cats, rabbits, and sometimes other fuzzy creatures that brought joy and maybe calm to the patients.  They didn’t perform any function other than being themselves.  In contrast, a service animal is trained to do a job.  According to the Americans with Disabilities Act (ADA), such an animal is “individually trained to do work or perform tasks for the benefit of an individual with a disability….”  Service animals are permitted by law to accompany their disabled owners into almost any business or organization that serves the public.

However, as the NY Times article notes, the line between therapy animals and psychiatric service animals has always been blurry.  Does an animal’s ability to actively soothe its owner qualify?  Adding to the confusion, the Department of Transportation (DOT) ruled in 2003 that comfort animals, not just service animals, were allowed to accompany airline passengers:  “Animals that assist persons with disabilities by providing emotional support qualify as service animals.” Such animals could be any species and needed no special training.   A 2006 NY Times article describes passengers bringing untrained goats and ducks aboard planes for “emotional support.”  Even if this was somehow legitimate, the DOT ruling was mistakenly extended to settings other than airplanes.  Although the ADA rules had not changed, the article tells of a “veritable Noah’s Ark” of animals brought to cafes, offices, and other businesses for emotional comfort, falsely justified by the rights of the disabled to bring service animals into these settings.  The article also relates abuses where healthy owners have brought animals into businesses by falsely claiming they are service animals.

As the menagerie of service and comfort animals has expanded, occasional community backlashes have charged that the animals represent health or safety hazards, or an excessive burden to others.  At a general level, this reflects a longstanding American debate between equality and relief from a tyrannical majority on the one hand, versus the view that minority entitlement or “special interests” demand too much of everyone else.  Medically disabled Americans have legal entitlements, including the right to use service animals, guaranteed by the ADA and other laws.  Such entitlements are a point of endless political contention.

Neurologists, I imagine, readily declare quadriplegics disabled, and harbor no misgivings about endorsing their “special interest” in a service animal.  I was less at ease declaring my patient disabled, and hesitated endorsing her “special interest” in keeping her dog for emotional comfort.  Is this simply because psychiatric disabilities are harder to quantify?  Is subjective disability a coherent concept?  In my next post, I will put psychiatric service animals in the larger context of psychiatric disability.

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